M+C meltdown hinders access to medications

December 1, 2002

The fact that health plans are abandoning Medicare+Choice at a slower rate than in previous years doesn't mask the fact that the exodus of plans only exacerbates the problem of lack of pharmaceutical coverage for the elderly. The Centers for Medicare and Medicaid Services announced recently that nine plans will exit the program, while another 24 will reduce service areas. While that's an improvement over last year, when 58 plans left, the defections still mean that about 200,000 beneficiaries will have to find new coverage.

The elderly are exhibiting a host of behaviors to make up for the lack of pharmacy coverage, according to "Prescription Use Behavior Among Medicare Beneficiaries With Capped Benefits," a study published in the September/October 2002 Journal of Managed Care Pharmacy. The authors surveyed 212 beneficiaries and found that, for instance, 27 percent of those who tried to make up for the lack of a pharmacy benefit by using samples obtained from their physician also took less than the prescribed amount of medication.